Magro Daniéla Oliveira, Lima Amanda Pereira, Coy Cláudio Saddy Rodrigues, Kotze Paulo Gustavo
Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Departamento de Cirurgia, Campinas, SP, Brasil.
Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, SP, Brasil.
Arq Gastroenterol. 2025 Jun 16;62:e24094. doi: 10.1590/S0004-2803.24612024-94. eCollection 2025.
Malnutrition, sarcopenia, and obesity can negatively impact the course of gastrointestinal surgery, increasing the risk of postoperative complications such as anastomotic dehiscence, reoperations, increased mortality and morbidity, and prolonged hospitalizations, leading to higher healthcare costs. Weight loss greater than 10% in the previous six months is a prognostic indicator of mortality in gastrointestinal surgeries and one of the few modifiable variables. Preoperative malnutrition prevalence ranges from 17% to 20%, increasing the risk of infectious complications, especially in malignant diseases. Obesity, i.e., body mass index (BMI) ≥30.0 kg/m2, also impairs the clinical course, contributing to postoperative complications and hospital mortality. Enhanced recovery protocols, like ERAS, are becoming standard practice, with preoperative nutritional interventions crucial for improving surgical outcomes. However, there is no consensus on the ideal preoperative dietary intervention, but regardless of nutritional status, all individuals are eligible for preoperative screening. The American Gastroenterological Association (AGA) proposes to assess malnutrition using signs and symptoms, including unintentional weight loss, edema, loss of fat and body muscle mass, and fluid retention, in addition to BMI ≤18.5 kg/m2. In the case of malnutrition, the use of oral supplementation, enteral nutrition (EN), or parenteral nutrition (PN) is recommended, even if there is a need to postpone surgery. This article discusses the importance of nutritional status screening and perioperative nutritional support, emphasizing the need for a comprehensive approach to improve patients' quality of life and reduce postoperative complications.
营养不良、肌肉减少症和肥胖会对胃肠手术的进程产生负面影响，增加术后并发症的风险，如吻合口裂开、再次手术、死亡率和发病率上升以及住院时间延长，从而导致更高的医疗成本。过去六个月体重减轻超过10%是胃肠手术死亡率的一个预后指标，也是少数可改变的变量之一。术前营养不良的患病率在17%至20%之间，增加了感染并发症的风险，尤其是在恶性疾病中。肥胖，即体重指数（BMI）≥30.0kg/m²，也会影响临床进程，导致术后并发症和医院死亡率上升。像加速康复外科（ERAS）这样的强化康复方案正成为标准做法，术前营养干预对于改善手术结果至关重要。然而，对于理想的术前饮食干预尚无共识，但无论营养状况如何，所有个体都有资格进行术前筛查。美国胃肠病学会（AGA）建议除了BMI≤18.5kg/m²外，还应使用体征和症状评估营养不良，包括非故意体重减轻、水肿、脂肪和身体肌肉量减少以及液体潴留。对于营养不良的情况，即使需要推迟手术，也建议使用口服补充剂、肠内营养（EN）或肠外营养（PN）。本文讨论了营养状况筛查和围手术期营养支持的重要性，强调需要采取综合方法来提高患者的生活质量并减少术后并发症。
